Health­care com­pa­nies be­gin to mea­sure the flu’s fi­nan­cial im­pact

Win­ter emer­gency-room in­flux caps off busy year

Modern Healthcare - - FRONT PAGE - Beth Kutscher

For 10 days in Jan­uary, Bay­health Med­i­cal Cen­ter was near grid­lock as pa­tients with win­ter ail­ments jammed its emer­gency de­part­ment and cre­ated bot­tle­necks that re­ver­ber­ated through­out the fa­cil­ity. The 310-bed hospi­tal in Dover, Del., saw a “tremen­dous in­flux of pa­tients” with in­fluenza, as well as norovirus and higher-than-usual cases of pneu­mo­nia, said Ann Keane, di­rec­tor of pa­tient care ser­vices. “Es­sen­tially what hap­pened is that things came to a halt in terms of pa­tient flow.”

The vol­ume was so great that the emer­gency de­part­ment ul­ti­mately went on di­ver­sion, and the hospi­tal opened an­other med­i­cal/sur­gi­cal hold­ing unit to ac­com­mo­date the ex­tra pa­tients.

Bay­health of­fered ex­ist­ing staff mem­bers in­cen­tives to work over­time and brought in ad­di­tional agency and travel nurses. “It’s a very ex­pen­sive propo­si­tion, but that’s what we need to do to pro­vide care for our pa­tients,” Keane said.

It’s a scene that re­peated it­self at hos­pi­tals across the coun­try as the flu sea­son last month reached epi­demic lev­els as mea­sured by mor­tal­i­ties. lite cam­pus was sup­posed to re­lieve some of the pres­sure, but while it saw twice as many pa­tients as an­tic­i­pated, it did not make a dent in the num­ber of pa­tients seen at the main cam­pus.

It’s un­clear whether over­flow­ing emer­gency rooms will trans­late into im­proved mar­gins as fi­nan­cial re­sults come in—or whether the ad­di­tional re­sources needed to care for pa­tients with lower-acu­ity con­di­tions might be a net strain on hospi­tal bal­ance sheets.

Dar­ren Lehrich, an an­a­lyst at Deutsche Bank, wrote in a note to clients that while the flu caused De­cem­ber vis­its to the emer­gency de­part­ment to spike, the same dra­matic uptick wasn’t seen in ad­mis­sions—a trend he ex­pected to con­tinue in the early months of this year.

In an earn­ings report last week, HCA, Nashville, the na­tion’s largest in­vestor-owned hospi­tal chain, re­ported that ER vis­its in­creased 12.7% in the fourth quar­ter of last year com­pared with the same pe­riod the pre­vi­ous year.

How­ever, same-fa­cil­ity in­pa­tient ad­mis­sions saw a more mod­est 4.3% boost. The hospi­tal gi­ant also saw an in­crease in both the

“It’s be­com­ing a per­fect storm, in a sense. That’s an­other rea­son you’re see­ing the ED vol­ume spike.”

—Dr. Louis Isaacson Emer­gency de­part­ment med­i­cal di­rec­tor

TeamHealth

It also capped off what was al­ready a busy year for hospi­tal emer­gency rooms.

At Bay­health, for in­stance, ER vol­ume in 2012 in­creased about 15% over the course of the year, Keane said. A newly opened sa­tel-

num­ber of unin­sured pa­tients at its fa­cil­i­ties as well as bad debt and char­ity care as a per­cent­age of its quar­terly rev­enue.

While win­ter ail­ments bring in pa­tients, their con­di­tions are gen­er­ally less se­vere and bring in lower re­im­burse­ment. As a re­sult, James Le­buhn, se­nior di­rec­tor at Fitch Rat­ings, noted that the rat­ings agency ex­pects this year’s flu sea­son to be over­all credit-neu­tral.

And there are other chal­lenges for hos­pi­tals, in­clud­ing in­creased staffing de­mands, unin­sured pa­tients who use the ER as a safety net and even the threat of read­mis­sions penal­ties.

For pay­ers, that means this year’s flu sea­son will be a costly one.

Hu­mana, one of the largest health in­surance com­pa­nies, ad­justed its earn­ings-per­share guid­ance for 2013, not­ing in an earn­ings re­lease that it in­curred higher flu-re­lated costs than it pre­vi­ously an­tic­i­pated. Re­tail phar­ma­cies such as Wal­greens also at­tested to higher sales of both flu-re­lated pre­scrip­tions and vac­cines.

Like its hospi­tal clients, TeamHealth, an out­sourced physi­cian staffing firm, re­ported that an ear­lier and more se­vere flu sea­son helped boost the vol­ume of pa­tients it saw. How­ever, it noted that pric­ing growth on its fee-for-ser­vice con­tracts was es­sen­tially flat as it saw less re­im­burse­ment as well as a more ad­verse payer mix.

Dr. Louis Isaacson, an emer­gency de­part­ment med­i­cal di­rec­tor at TeamHealth, said the flu sea­son ex­poses what is al­ready a fault line in pri­mary care, as pa­tients with­out a reg­u­lar doc­tor flood ERs for same-day treat­ment. Some of th­ese pa­tients are unin­sured, but oth­ers sim­ply have not fit rou­tine care into their hec­tic sched­ules. And it’s a sit­u­a­tion that the staffing firm had been see­ing for the past year.

“It’s be­com­ing a per­fect storm, in a sense,” Isaacson said. “That’s an­other rea­son you’re see­ing the ED vol­ume spike.”

Grady Health Sys­tem, At­lanta, sim­i­larly saw a dou­ble-digit per­cent­age in­crease in pa­tient vis­its in 2012, track­ing 119,000 pa­tient en­coun­ters com­pared with the pre­vi­ous year’s roughly 105,000.

Dr. Leon Ha­ley, chief of emer­gency medicine for the sys­tem, whose flag­ship fa­cil­ity is 660-bed Grady Me­mo­rial Hospi­tal, noted that more pa­tients are coming in with low-acu­ity con­di­tions such as the flu, as well as high-acu­ity con­di­tions such as stroke and trauma. “The in­crease is across the board,” he said.

Ha­ley added that emer­gency de­part­ments na­tion­wide have been see­ing ad­di­tional pa­tient vol­ume ev­ery year for the past 10 to 15 years, at­tribut­ing the in­crease to pa­tients with­out ac­cess to pri­mary-care providers, as well as fewer emer­gency de­part­ments in op­er­a­tion.

Grady, for its part, has been work­ing to stream­line pro­cesses and has tapped a con­sult­ing firm to eval­u­ate a po­ten­tial re­design of its emer­gency de­part­ment. “We’ve got pretty strained hos­pi­tals,” Ha­ley said. “We’re work­ing on adding more re­sources, but you can’t flip a switch and have things pop up.”

AP PHOTO

Phar­ma­cist Sta­cia Wood­cock ad­min­is­ters a flu shot last month for Wal­greens in New York. The phar­macy said it has seen higher sales of flu-re­lated drugs as well as vac­cines.

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